Health Evolution | October 27, 2020
Trenor Williams, MD, co-founder and CEO of Socially Determined, is resolute in his quest to inform and inspire executives, policymakers and leaders to make social determinants of health a critical element of their enterprise strategy through data and analytics.
The entrepreneur leads a company solely focused on social determinants and leveraging social risk intelligence to enable more human interactions at the person-level.
Health Evolution interviewed Williams about the driving force behind Socially Determined, the illustrated ROI of social determinants, and the opportunity to coalesce providers, payers, state government and community-based organizations to create a common view of what needs to happen and how to get there.
What was the inspiration or origin story behind the founding of Socially Determined?
Williams: My mom is a social worker. She ran the Area Agency on Aging in in southwestern Virginia for 32 years, which includes senior programs such as Meals on Wheels. Six years ago, I was with her while my dad had cardiac issues and we had a lot of conversations about how her social workers conduct in-person interviews for eligible people at their homes. It struck me that the amount of data social workers had compared to a family practice was simply amazing. They could see if the people were socially isolated, what was in the fridge, or how close the nearest grocery store is to them. In this case, Meals on Wheels had such a massive impact.
So that was one piece of the puzzle that got me thinking, and the second was another woman, Theresa Cullen, MD, National CMIO of Veterans Health Administration.
She engaged my last company to look at social risk for veterans because the VA understood homelessness, suicidality and being able to characterize that risk. Her guidance made me think about it from a much more structured point of view.
Based on those two experiences, I started to put together a business case that resulted in three general philosophical statements: 1) Social risk – including food, housing and transportation – all have a dramatic impact on health and health outcomes that has only accelerated in the last few years. 2) The U.S. healthcare system does a poor job gathering these insights in a usable way, so addressing the related challenges in a scalable, sustainable way feels impossible. 3) If we can align financial incentives and identify where social risk is having an impact, we can address inequities and gaps in care.
In a nutshell, there’s a really big problem that no one has solved yet, but it’s possible to align the money in a way that motivates positive change. That’s the business. And frankly, it can also have an incredible impact on individuals, families and communities.
The idea of social determinants has been around for a long time, yet they are often perceived as a soft issue. What are the business implications that are perhaps not as well recognized as they ought to be?
Williams: We see two challenges, and the first is whether or not there is a business case. There is good evidence about the ROI, financial and clinical impact social determinants can have on a health systems or health plan’s bottom line – it just doesn’t get shared enough. For example, Geisinger addressed food insecurity in diabetic populations and saved approximately $26,000 per member. ProMedica’s initiative to provide financial and food clinics has also had a dramatic and measurable impact on patients and members. So there is really good data out there and it’s always great to add to that compendium. We are very fortunate because the fact that we work with systems, plans, government, and others enables us to measure that impact in a comprehensive way as well.
The second challenge is whether any single organization can accomplish this alone, and the answer is easy: no, they can’t. The challenge is that a health system sees somebody as a patient, the health plan sees that same patient as a member, the state government sees them as a citizen, and community organizations see them as recipient or participants. And those are more than just different labels that apply to the same person. It’s representative of how different organizations think about, view and treat the same person.
What are the opportunities within those problems?
Williams: The opportunity is to bring these entities together to create a common view for what risk looks like, and then create a common path to get there. It’s in everyone’s best interest to bring our health systems, health plans, and state governments together to actually measure the impact as well.
Trenor Williams, MD, Co-founder and CEO of Socially Determined
For provider, payer or life sciences CEOs, how does the Socially Determined platform work?
Williams: Whenever I meet with CEOs or other leaders, the first thing I do is ask a simple question: If you could know more about your employees, patients, or members around their personal risk or the risk in the community where they live and work, could you deliver more efficient and effective care for that person? It’s a really simple question and by and large everybody says, “Yes.” I’m setting the stage because the technology allows organizations — regardless of whether it’s a state government, health plan, health system, employer or life sciences company — to be able to create a common view of what risk looks like for every community they care about. In some cases, it’s a national view into the resources available and a risk baseline at the person level to understand the risk of all the people they care about. It doesn’t matter if that’s 40,000 employees or 300,000 people in a managed Medicaid plan.
If you start with that baseline, then apply it to clinical and claims data, and link that social risk to disease, you can prioritize specific areas and populations where you can have the biggest impact. For example, you can identify where people with diabetes are doing worse because of social risk, such as food insecurity or housing instability versus people with diabetes who don’t have those risks. The platform provides visibility into where social risk is driving variation in outcomes and as a result, you know where and how to intervene.
Socially Determined describes itself as being entirely focused on social determinants. What does that mean? Or how does it inform what you as CEO do?
Williams: Creating a team with deep domain knowledge is valuable in and of itself. We didn’t start out this way but we have become experts in this complex space while public health officials have been talking about social determinants in one form or another for more than 50 years. We built a team that brings together data scientists who are experts and clinicians who are experts, and purpose-built a platform to surface the data that matters. But beyond that, our experts who are thinking only about social determinants and social risk intelligence, are on the ground with our customers helping them understand and take action on that data.
This work is so complex because it requires new types of data from outside the healthcare system that takes a lot of knowledge to use and manage correctly. You have to use this data from myriad sources in concert with clinical data or health care data, and that requires a lot of expertise. Nobody should just mess around with social determinants as a side hustle. It takes dedicated teamwork and focus and we think that matters.
How has 2020, the pandemic, social injustice, turbulent election season – if that figures in – changed Socially Determined or your strategy?
Williams: It has accelerated conversations everywhere and it’s not just COVID, it’s certainly also the social protests that have gone on. It has put a bright light on the inequities in our communities and in populations with communities of color. Everybody has been interested in having this conversation. For us, being able to serve as a resource in this turbulent challenging time is really important because we see the best impact at a person, family or community level when organizations come together. Now that more people and organizations are talking about this, there are natural opportunities that will enable us all to be more impactful by driving greater value and greater impact.
What should existing and prospective clients expect from Socially Determined in the next 18-24 months? And what about 3-5 years?
Williams: Our goal with every customer is to ensure that they don’t see social risk intelligence as a separate and distinct initiative they are trying to manage. As they look across the next five years, we want to help them think about how they can embed that intelligence and those insights into everything they do. It’s a not a population health strategy and a social determinants strategy, it’s an integrated strategy incorporating a new data set they might not have had access to before – a new set of insight.
More broadly, over the next eighteen months I see people, organizations, entities, and sectors coming together around this topic so they all can have greater impact and lessen investments instead of everyone doing it themselves.
What are you most proud of as a founder and CEO?
Williams: The little stories. For example, in the last couple weeks a care manager using our platform was on the phone with a patient and their power was turned off during the call. Because that patient was part of our platform, the care manager determined who to contact about that and then was able to help get her power turned back on that day. Another of our favorite stories is a customer that hasn’t rolled out a single intervention but, instead, has altered how they use the risk insight data to fundamentally change every conversation they have with a member. Now, their care managers are armed with this information at a person level. So when they call Ms. Johnson, they know about her risk exposure. They know about food insecurity risk and the drivers of that because she doesn’t have any grocery stores nearby. That’s just an example of how they can have a thoughtful informed conversation with people who need it.
I started with my mom and I think stories like that – where we’ve been able to make a real difference – are the kind of things that would make my mom proud and will ultimately contribute to our success in the eyes of our partners.
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